Serious maternal complications after early preterm delivery (24-33 weeks' gestation)

Uma M. Reddy, Madeline Murguia Rice, William A. Grobman, Jennifer L. Bailit, Ronald J. Wapner, Michael W. Varner, John M. Thorp, Kenneth J. Leveno, Steve N. Caritis, Mona Prasad, Alan T N Tita, George Saade, Yoram Sorokin, Dwight J. Rouse, Sean C. Blackwell, Jorge E. Tolosa, C. Spong, S. Tolivaisa, M. Talucci, M. ZylfijajZ. Reid, R. Leed, J. Benson, S. Forester, C. Kitto, S. Davis, M. Falk, C. Perez, K. Hill, A. Sowles, J. Postma, S. Alexander, G. Andersen, V. Scott, V. Morby, K. Jolley, J. Miller, B. Berg, K. Dorman, J. Mitchell, E. Kaluta, K. Clark, K. Spicer, S. Timlin, K. Wilson, L. Moseley, M. Santillan, J. Price, K. Buentipo, V. Bludau, T. Thomas, L. Fay, C. Melton, J. Kingsbery, R. Benezue, H. Simhan, M. Bickus, D. Fischer, T. Kamon, D. Deangelis, B. Mercer, C. Milluzzi, W. Dalton, T. Dotson, P. McDonald, C. Brezine, A. McGrail, C. Latimer, L. Guzzo, F. Johnson, L. Gerwig, S. Fyffe, D. Loux, S. Frantz, D. Cline, S. Wylie, J. Iams, M. Wallace, A. Northen, J. Grant, C. Colquitt, D. Rouse, W. Andrews, G. Mallett, M. Ramos-Brinson, A. Roy, L. Stein, P. Campbell, C. Collins, N. Jackson, M. Dinsmoor, J. Senka, K. Paychek, A. Peaceman, J. Moss, Ashley Salazar, A. Acosta, Gary Hankins, N. Hauff, L. Palmer, P. Lockhart, D. Driscoll, L. Wynn, C. Sudz, D. Dengate, C. Girard, S. Field, P. Breault, F. Smith, N. Annunziata, D. Allard, J. Silva, M. Gamage, J. Hunt, J. Tillinghast, N. Corcoran, M. Jimenez, F. Ortiz, P. Givens, B. Rech, C. Moran, M. Hutchinson, Z. Spears, C. Carreno, B. Heaps, G. Zamora, J. Seguin, M. Rincon, J. Snyder, C. Farrar, E. Lairson, C. Bonino, W. Smith, K. Beach, S. Van Dyke, S. Butcher, E. Thom, Y. Zhao, P. McGee, V. Momirova, R. Palugod, B. Reamer, M. Larsen, T. Spangler, V. Bhandaru, J. P. Vandorsten

    Research output: Contribution to journalArticle

    38 Citations (Scopus)

    Abstract

    Objective We sought to describe the prevalence of serious maternal complications following early preterm birth by gestational age (GA), delivery route, and type of cesarean incision. Study Design Trained personnel abstracted data from maternal and neonatal charts for all deliveries on randomly selected days representing one third of deliveries across 25 US hospitals over 3 years (n = 115,502). All women delivering nonanomalous singletons between 23-33 weeks' gestation were included. Women were excluded for antepartum stillbirth and highly morbid conditions for which route of delivery would not likely impact morbidity including nonreassuring fetal status, cord prolapse, placenta previa, placenta accreta, placental abruption, and severe and unstable maternal conditions (cardiopulmonary collapse, acute respiratory distress syndrome, seizures). Serious maternal complications were defined as: hemorrhage (blood loss ≥1500 mL, blood transfusion, or hysterectomy for hemorrhage), infection (endometritis, wound dehiscence, or wound infection requiring antibiotics, reopening, or unexpected procedure), intensive care unit admission, or death. Delivery route was categorized as classic cesarean delivery (CCD), low transverse cesarean delivery (LTCD), low vertical cesarean delivery (LVCD), and vaginal delivery. Association of delivery route with complications was estimated using multivariable regression models yielding adjusted relative risks (aRR) controlling for maternal age, race, body mass index, hypertension, diabetes, preterm premature rupture of membranes, preterm labor, GA, and hospital of delivery. Results Of 2659 women who met criteria for inclusion in this analysis, 8.6% of women experienced serious maternal complications. Complications were associated with GA and were highest between 23-27 weeks of gestation. The frequency of complications was associated with delivery route; compared with 3.5% of vaginal delivery, 23.0% of CCD (aRR, 3.54; 95% confidence interval (CI), 2.29-5.48), 12.1% of LTCD (aRR, 2.59; 95% CI, 1.77-3.77), and 10.3% of LVCD (aRR, 2.27; 95% CI, 0.68-7.55) experienced complications. There was no significant difference in complication rates between CCD and LTCD (aRR, 1.37; 95% CI, 0.95-1.97) or between CCD and LVCD (aRR, 1.56; 95% CI, 0.48-5.07). Conclusion The risk of maternal complications after early preterm delivery is substantial, particularly in women who undergo cesarean delivery. Obstetricians need to be prepared to manage potential hemorrhage, infection, and intensive care unit admission for early preterm births requiring cesarean delivery.

    Original languageEnglish (US)
    Pages (from-to)538.e1-538.e9
    JournalAmerican Journal of Obstetrics and Gynecology
    Volume213
    Issue number4
    DOIs
    StatePublished - Oct 1 2015

    Fingerprint

    Mothers
    Pregnancy
    Confidence Intervals
    Gestational Age
    Premature Birth
    Wound Infection
    Hemorrhage
    Intensive Care Units
    Placenta Accreta
    Placenta Previa
    Abruptio Placentae
    Endometritis
    Fetal Distress
    Stillbirth
    Premature Obstetric Labor
    Prolapse
    Adult Respiratory Distress Syndrome
    Maternal Age
    Hysterectomy
    Blood Transfusion

    Keywords

    • classic cesarean delivery
    • early preterm delivery
    • hemorrhage
    • infection
    • intensive care unit admission
    • maternal morbidity

    ASJC Scopus subject areas

    • Obstetrics and Gynecology

    Cite this

    Reddy, U. M., Rice, M. M., Grobman, W. A., Bailit, J. L., Wapner, R. J., Varner, M. W., ... Vandorsten, J. P. (2015). Serious maternal complications after early preterm delivery (24-33 weeks' gestation). American Journal of Obstetrics and Gynecology, 213(4), 538.e1-538.e9. https://doi.org/10.1016/j.ajog.2015.06.064

    Serious maternal complications after early preterm delivery (24-33 weeks' gestation). / Reddy, Uma M.; Rice, Madeline Murguia; Grobman, William A.; Bailit, Jennifer L.; Wapner, Ronald J.; Varner, Michael W.; Thorp, John M.; Leveno, Kenneth J.; Caritis, Steve N.; Prasad, Mona; Tita, Alan T N; Saade, George; Sorokin, Yoram; Rouse, Dwight J.; Blackwell, Sean C.; Tolosa, Jorge E.; Spong, C.; Tolivaisa, S.; Talucci, M.; Zylfijaj, M.; Reid, Z.; Leed, R.; Benson, J.; Forester, S.; Kitto, C.; Davis, S.; Falk, M.; Perez, C.; Hill, K.; Sowles, A.; Postma, J.; Alexander, S.; Andersen, G.; Scott, V.; Morby, V.; Jolley, K.; Miller, J.; Berg, B.; Dorman, K.; Mitchell, J.; Kaluta, E.; Clark, K.; Spicer, K.; Timlin, S.; Wilson, K.; Moseley, L.; Santillan, M.; Price, J.; Buentipo, K.; Bludau, V.; Thomas, T.; Fay, L.; Melton, C.; Kingsbery, J.; Benezue, R.; Simhan, H.; Bickus, M.; Fischer, D.; Kamon, T.; Deangelis, D.; Mercer, B.; Milluzzi, C.; Dalton, W.; Dotson, T.; McDonald, P.; Brezine, C.; McGrail, A.; Latimer, C.; Guzzo, L.; Johnson, F.; Gerwig, L.; Fyffe, S.; Loux, D.; Frantz, S.; Cline, D.; Wylie, S.; Iams, J.; Wallace, M.; Northen, A.; Grant, J.; Colquitt, C.; Rouse, D.; Andrews, W.; Mallett, G.; Ramos-Brinson, M.; Roy, A.; Stein, L.; Campbell, P.; Collins, C.; Jackson, N.; Dinsmoor, M.; Senka, J.; Paychek, K.; Peaceman, A.; Moss, J.; Salazar, Ashley; Acosta, A.; Hankins, Gary; Hauff, N.; Palmer, L.; Lockhart, P.; Driscoll, D.; Wynn, L.; Sudz, C.; Dengate, D.; Girard, C.; Field, S.; Breault, P.; Smith, F.; Annunziata, N.; Allard, D.; Silva, J.; Gamage, M.; Hunt, J.; Tillinghast, J.; Corcoran, N.; Jimenez, M.; Ortiz, F.; Givens, P.; Rech, B.; Moran, C.; Hutchinson, M.; Spears, Z.; Carreno, C.; Heaps, B.; Zamora, G.; Seguin, J.; Rincon, M.; Snyder, J.; Farrar, C.; Lairson, E.; Bonino, C.; Smith, W.; Beach, K.; Van Dyke, S.; Butcher, S.; Thom, E.; Zhao, Y.; McGee, P.; Momirova, V.; Palugod, R.; Reamer, B.; Larsen, M.; Spangler, T.; Bhandaru, V.; Vandorsten, J. P.

    In: American Journal of Obstetrics and Gynecology, Vol. 213, No. 4, 01.10.2015, p. 538.e1-538.e9.

    Research output: Contribution to journalArticle

    Reddy, UM, Rice, MM, Grobman, WA, Bailit, JL, Wapner, RJ, Varner, MW, Thorp, JM, Leveno, KJ, Caritis, SN, Prasad, M, Tita, ATN, Saade, G, Sorokin, Y, Rouse, DJ, Blackwell, SC, Tolosa, JE, Spong, C, Tolivaisa, S, Talucci, M, Zylfijaj, M, Reid, Z, Leed, R, Benson, J, Forester, S, Kitto, C, Davis, S, Falk, M, Perez, C, Hill, K, Sowles, A, Postma, J, Alexander, S, Andersen, G, Scott, V, Morby, V, Jolley, K, Miller, J, Berg, B, Dorman, K, Mitchell, J, Kaluta, E, Clark, K, Spicer, K, Timlin, S, Wilson, K, Moseley, L, Santillan, M, Price, J, Buentipo, K, Bludau, V, Thomas, T, Fay, L, Melton, C, Kingsbery, J, Benezue, R, Simhan, H, Bickus, M, Fischer, D, Kamon, T, Deangelis, D, Mercer, B, Milluzzi, C, Dalton, W, Dotson, T, McDonald, P, Brezine, C, McGrail, A, Latimer, C, Guzzo, L, Johnson, F, Gerwig, L, Fyffe, S, Loux, D, Frantz, S, Cline, D, Wylie, S, Iams, J, Wallace, M, Northen, A, Grant, J, Colquitt, C, Rouse, D, Andrews, W, Mallett, G, Ramos-Brinson, M, Roy, A, Stein, L, Campbell, P, Collins, C, Jackson, N, Dinsmoor, M, Senka, J, Paychek, K, Peaceman, A, Moss, J, Salazar, A, Acosta, A, Hankins, G, Hauff, N, Palmer, L, Lockhart, P, Driscoll, D, Wynn, L, Sudz, C, Dengate, D, Girard, C, Field, S, Breault, P, Smith, F, Annunziata, N, Allard, D, Silva, J, Gamage, M, Hunt, J, Tillinghast, J, Corcoran, N, Jimenez, M, Ortiz, F, Givens, P, Rech, B, Moran, C, Hutchinson, M, Spears, Z, Carreno, C, Heaps, B, Zamora, G, Seguin, J, Rincon, M, Snyder, J, Farrar, C, Lairson, E, Bonino, C, Smith, W, Beach, K, Van Dyke, S, Butcher, S, Thom, E, Zhao, Y, McGee, P, Momirova, V, Palugod, R, Reamer, B, Larsen, M, Spangler, T, Bhandaru, V & Vandorsten, JP 2015, 'Serious maternal complications after early preterm delivery (24-33 weeks' gestation)', American Journal of Obstetrics and Gynecology, vol. 213, no. 4, pp. 538.e1-538.e9. https://doi.org/10.1016/j.ajog.2015.06.064
    Reddy, Uma M. ; Rice, Madeline Murguia ; Grobman, William A. ; Bailit, Jennifer L. ; Wapner, Ronald J. ; Varner, Michael W. ; Thorp, John M. ; Leveno, Kenneth J. ; Caritis, Steve N. ; Prasad, Mona ; Tita, Alan T N ; Saade, George ; Sorokin, Yoram ; Rouse, Dwight J. ; Blackwell, Sean C. ; Tolosa, Jorge E. ; Spong, C. ; Tolivaisa, S. ; Talucci, M. ; Zylfijaj, M. ; Reid, Z. ; Leed, R. ; Benson, J. ; Forester, S. ; Kitto, C. ; Davis, S. ; Falk, M. ; Perez, C. ; Hill, K. ; Sowles, A. ; Postma, J. ; Alexander, S. ; Andersen, G. ; Scott, V. ; Morby, V. ; Jolley, K. ; Miller, J. ; Berg, B. ; Dorman, K. ; Mitchell, J. ; Kaluta, E. ; Clark, K. ; Spicer, K. ; Timlin, S. ; Wilson, K. ; Moseley, L. ; Santillan, M. ; Price, J. ; Buentipo, K. ; Bludau, V. ; Thomas, T. ; Fay, L. ; Melton, C. ; Kingsbery, J. ; Benezue, R. ; Simhan, H. ; Bickus, M. ; Fischer, D. ; Kamon, T. ; Deangelis, D. ; Mercer, B. ; Milluzzi, C. ; Dalton, W. ; Dotson, T. ; McDonald, P. ; Brezine, C. ; McGrail, A. ; Latimer, C. ; Guzzo, L. ; Johnson, F. ; Gerwig, L. ; Fyffe, S. ; Loux, D. ; Frantz, S. ; Cline, D. ; Wylie, S. ; Iams, J. ; Wallace, M. ; Northen, A. ; Grant, J. ; Colquitt, C. ; Rouse, D. ; Andrews, W. ; Mallett, G. ; Ramos-Brinson, M. ; Roy, A. ; Stein, L. ; Campbell, P. ; Collins, C. ; Jackson, N. ; Dinsmoor, M. ; Senka, J. ; Paychek, K. ; Peaceman, A. ; Moss, J. ; Salazar, Ashley ; Acosta, A. ; Hankins, Gary ; Hauff, N. ; Palmer, L. ; Lockhart, P. ; Driscoll, D. ; Wynn, L. ; Sudz, C. ; Dengate, D. ; Girard, C. ; Field, S. ; Breault, P. ; Smith, F. ; Annunziata, N. ; Allard, D. ; Silva, J. ; Gamage, M. ; Hunt, J. ; Tillinghast, J. ; Corcoran, N. ; Jimenez, M. ; Ortiz, F. ; Givens, P. ; Rech, B. ; Moran, C. ; Hutchinson, M. ; Spears, Z. ; Carreno, C. ; Heaps, B. ; Zamora, G. ; Seguin, J. ; Rincon, M. ; Snyder, J. ; Farrar, C. ; Lairson, E. ; Bonino, C. ; Smith, W. ; Beach, K. ; Van Dyke, S. ; Butcher, S. ; Thom, E. ; Zhao, Y. ; McGee, P. ; Momirova, V. ; Palugod, R. ; Reamer, B. ; Larsen, M. ; Spangler, T. ; Bhandaru, V. ; Vandorsten, J. P. / Serious maternal complications after early preterm delivery (24-33 weeks' gestation). In: American Journal of Obstetrics and Gynecology. 2015 ; Vol. 213, No. 4. pp. 538.e1-538.e9.
    @article{c52503f9fa9142b08f0151db0bc6a65c,
    title = "Serious maternal complications after early preterm delivery (24-33 weeks' gestation)",
    abstract = "Objective We sought to describe the prevalence of serious maternal complications following early preterm birth by gestational age (GA), delivery route, and type of cesarean incision. Study Design Trained personnel abstracted data from maternal and neonatal charts for all deliveries on randomly selected days representing one third of deliveries across 25 US hospitals over 3 years (n = 115,502). All women delivering nonanomalous singletons between 23-33 weeks' gestation were included. Women were excluded for antepartum stillbirth and highly morbid conditions for which route of delivery would not likely impact morbidity including nonreassuring fetal status, cord prolapse, placenta previa, placenta accreta, placental abruption, and severe and unstable maternal conditions (cardiopulmonary collapse, acute respiratory distress syndrome, seizures). Serious maternal complications were defined as: hemorrhage (blood loss ≥1500 mL, blood transfusion, or hysterectomy for hemorrhage), infection (endometritis, wound dehiscence, or wound infection requiring antibiotics, reopening, or unexpected procedure), intensive care unit admission, or death. Delivery route was categorized as classic cesarean delivery (CCD), low transverse cesarean delivery (LTCD), low vertical cesarean delivery (LVCD), and vaginal delivery. Association of delivery route with complications was estimated using multivariable regression models yielding adjusted relative risks (aRR) controlling for maternal age, race, body mass index, hypertension, diabetes, preterm premature rupture of membranes, preterm labor, GA, and hospital of delivery. Results Of 2659 women who met criteria for inclusion in this analysis, 8.6{\%} of women experienced serious maternal complications. Complications were associated with GA and were highest between 23-27 weeks of gestation. The frequency of complications was associated with delivery route; compared with 3.5{\%} of vaginal delivery, 23.0{\%} of CCD (aRR, 3.54; 95{\%} confidence interval (CI), 2.29-5.48), 12.1{\%} of LTCD (aRR, 2.59; 95{\%} CI, 1.77-3.77), and 10.3{\%} of LVCD (aRR, 2.27; 95{\%} CI, 0.68-7.55) experienced complications. There was no significant difference in complication rates between CCD and LTCD (aRR, 1.37; 95{\%} CI, 0.95-1.97) or between CCD and LVCD (aRR, 1.56; 95{\%} CI, 0.48-5.07). Conclusion The risk of maternal complications after early preterm delivery is substantial, particularly in women who undergo cesarean delivery. Obstetricians need to be prepared to manage potential hemorrhage, infection, and intensive care unit admission for early preterm births requiring cesarean delivery.",
    keywords = "classic cesarean delivery, early preterm delivery, hemorrhage, infection, intensive care unit admission, maternal morbidity",
    author = "Reddy, {Uma M.} and Rice, {Madeline Murguia} and Grobman, {William A.} and Bailit, {Jennifer L.} and Wapner, {Ronald J.} and Varner, {Michael W.} and Thorp, {John M.} and Leveno, {Kenneth J.} and Caritis, {Steve N.} and Mona Prasad and Tita, {Alan T N} and George Saade and Yoram Sorokin and Rouse, {Dwight J.} and Blackwell, {Sean C.} and Tolosa, {Jorge E.} and C. Spong and S. Tolivaisa and M. Talucci and M. Zylfijaj and Z. Reid and R. Leed and J. Benson and S. Forester and C. Kitto and S. Davis and M. Falk and C. Perez and K. Hill and A. Sowles and J. Postma and S. Alexander and G. Andersen and V. Scott and V. Morby and K. Jolley and J. Miller and B. Berg and K. Dorman and J. Mitchell and E. Kaluta and K. Clark and K. Spicer and S. Timlin and K. Wilson and L. Moseley and M. Santillan and J. Price and K. Buentipo and V. Bludau and T. Thomas and L. Fay and C. Melton and J. Kingsbery and R. Benezue and H. Simhan and M. Bickus and D. Fischer and T. Kamon and D. Deangelis and B. Mercer and C. Milluzzi and W. Dalton and T. Dotson and P. McDonald and C. Brezine and A. McGrail and C. Latimer and L. Guzzo and F. Johnson and L. Gerwig and S. Fyffe and D. Loux and S. Frantz and D. Cline and S. Wylie and J. Iams and M. Wallace and A. Northen and J. Grant and C. Colquitt and D. Rouse and W. Andrews and G. Mallett and M. Ramos-Brinson and A. Roy and L. Stein and P. Campbell and C. Collins and N. Jackson and M. Dinsmoor and J. Senka and K. Paychek and A. Peaceman and J. Moss and Ashley Salazar and A. Acosta and Gary Hankins and N. Hauff and L. Palmer and P. Lockhart and D. Driscoll and L. Wynn and C. Sudz and D. Dengate and C. Girard and S. Field and P. Breault and F. Smith and N. Annunziata and D. Allard and J. Silva and M. Gamage and J. Hunt and J. Tillinghast and N. Corcoran and M. Jimenez and F. Ortiz and P. Givens and B. Rech and C. Moran and M. Hutchinson and Z. Spears and C. Carreno and B. Heaps and G. Zamora and J. Seguin and M. Rincon and J. Snyder and C. Farrar and E. Lairson and C. Bonino and W. Smith and K. Beach and {Van Dyke}, S. and S. Butcher and E. Thom and Y. Zhao and P. McGee and V. Momirova and R. Palugod and B. Reamer and M. Larsen and T. Spangler and V. Bhandaru and Vandorsten, {J. P.}",
    year = "2015",
    month = "10",
    day = "1",
    doi = "10.1016/j.ajog.2015.06.064",
    language = "English (US)",
    volume = "213",
    pages = "538.e1--538.e9",
    journal = "American Journal of Obstetrics and Gynecology",
    issn = "0002-9378",
    publisher = "Mosby Inc.",
    number = "4",

    }

    TY - JOUR

    T1 - Serious maternal complications after early preterm delivery (24-33 weeks' gestation)

    AU - Reddy, Uma M.

    AU - Rice, Madeline Murguia

    AU - Grobman, William A.

    AU - Bailit, Jennifer L.

    AU - Wapner, Ronald J.

    AU - Varner, Michael W.

    AU - Thorp, John M.

    AU - Leveno, Kenneth J.

    AU - Caritis, Steve N.

    AU - Prasad, Mona

    AU - Tita, Alan T N

    AU - Saade, George

    AU - Sorokin, Yoram

    AU - Rouse, Dwight J.

    AU - Blackwell, Sean C.

    AU - Tolosa, Jorge E.

    AU - Spong, C.

    AU - Tolivaisa, S.

    AU - Talucci, M.

    AU - Zylfijaj, M.

    AU - Reid, Z.

    AU - Leed, R.

    AU - Benson, J.

    AU - Forester, S.

    AU - Kitto, C.

    AU - Davis, S.

    AU - Falk, M.

    AU - Perez, C.

    AU - Hill, K.

    AU - Sowles, A.

    AU - Postma, J.

    AU - Alexander, S.

    AU - Andersen, G.

    AU - Scott, V.

    AU - Morby, V.

    AU - Jolley, K.

    AU - Miller, J.

    AU - Berg, B.

    AU - Dorman, K.

    AU - Mitchell, J.

    AU - Kaluta, E.

    AU - Clark, K.

    AU - Spicer, K.

    AU - Timlin, S.

    AU - Wilson, K.

    AU - Moseley, L.

    AU - Santillan, M.

    AU - Price, J.

    AU - Buentipo, K.

    AU - Bludau, V.

    AU - Thomas, T.

    AU - Fay, L.

    AU - Melton, C.

    AU - Kingsbery, J.

    AU - Benezue, R.

    AU - Simhan, H.

    AU - Bickus, M.

    AU - Fischer, D.

    AU - Kamon, T.

    AU - Deangelis, D.

    AU - Mercer, B.

    AU - Milluzzi, C.

    AU - Dalton, W.

    AU - Dotson, T.

    AU - McDonald, P.

    AU - Brezine, C.

    AU - McGrail, A.

    AU - Latimer, C.

    AU - Guzzo, L.

    AU - Johnson, F.

    AU - Gerwig, L.

    AU - Fyffe, S.

    AU - Loux, D.

    AU - Frantz, S.

    AU - Cline, D.

    AU - Wylie, S.

    AU - Iams, J.

    AU - Wallace, M.

    AU - Northen, A.

    AU - Grant, J.

    AU - Colquitt, C.

    AU - Rouse, D.

    AU - Andrews, W.

    AU - Mallett, G.

    AU - Ramos-Brinson, M.

    AU - Roy, A.

    AU - Stein, L.

    AU - Campbell, P.

    AU - Collins, C.

    AU - Jackson, N.

    AU - Dinsmoor, M.

    AU - Senka, J.

    AU - Paychek, K.

    AU - Peaceman, A.

    AU - Moss, J.

    AU - Salazar, Ashley

    AU - Acosta, A.

    AU - Hankins, Gary

    AU - Hauff, N.

    AU - Palmer, L.

    AU - Lockhart, P.

    AU - Driscoll, D.

    AU - Wynn, L.

    AU - Sudz, C.

    AU - Dengate, D.

    AU - Girard, C.

    AU - Field, S.

    AU - Breault, P.

    AU - Smith, F.

    AU - Annunziata, N.

    AU - Allard, D.

    AU - Silva, J.

    AU - Gamage, M.

    AU - Hunt, J.

    AU - Tillinghast, J.

    AU - Corcoran, N.

    AU - Jimenez, M.

    AU - Ortiz, F.

    AU - Givens, P.

    AU - Rech, B.

    AU - Moran, C.

    AU - Hutchinson, M.

    AU - Spears, Z.

    AU - Carreno, C.

    AU - Heaps, B.

    AU - Zamora, G.

    AU - Seguin, J.

    AU - Rincon, M.

    AU - Snyder, J.

    AU - Farrar, C.

    AU - Lairson, E.

    AU - Bonino, C.

    AU - Smith, W.

    AU - Beach, K.

    AU - Van Dyke, S.

    AU - Butcher, S.

    AU - Thom, E.

    AU - Zhao, Y.

    AU - McGee, P.

    AU - Momirova, V.

    AU - Palugod, R.

    AU - Reamer, B.

    AU - Larsen, M.

    AU - Spangler, T.

    AU - Bhandaru, V.

    AU - Vandorsten, J. P.

    PY - 2015/10/1

    Y1 - 2015/10/1

    N2 - Objective We sought to describe the prevalence of serious maternal complications following early preterm birth by gestational age (GA), delivery route, and type of cesarean incision. Study Design Trained personnel abstracted data from maternal and neonatal charts for all deliveries on randomly selected days representing one third of deliveries across 25 US hospitals over 3 years (n = 115,502). All women delivering nonanomalous singletons between 23-33 weeks' gestation were included. Women were excluded for antepartum stillbirth and highly morbid conditions for which route of delivery would not likely impact morbidity including nonreassuring fetal status, cord prolapse, placenta previa, placenta accreta, placental abruption, and severe and unstable maternal conditions (cardiopulmonary collapse, acute respiratory distress syndrome, seizures). Serious maternal complications were defined as: hemorrhage (blood loss ≥1500 mL, blood transfusion, or hysterectomy for hemorrhage), infection (endometritis, wound dehiscence, or wound infection requiring antibiotics, reopening, or unexpected procedure), intensive care unit admission, or death. Delivery route was categorized as classic cesarean delivery (CCD), low transverse cesarean delivery (LTCD), low vertical cesarean delivery (LVCD), and vaginal delivery. Association of delivery route with complications was estimated using multivariable regression models yielding adjusted relative risks (aRR) controlling for maternal age, race, body mass index, hypertension, diabetes, preterm premature rupture of membranes, preterm labor, GA, and hospital of delivery. Results Of 2659 women who met criteria for inclusion in this analysis, 8.6% of women experienced serious maternal complications. Complications were associated with GA and were highest between 23-27 weeks of gestation. The frequency of complications was associated with delivery route; compared with 3.5% of vaginal delivery, 23.0% of CCD (aRR, 3.54; 95% confidence interval (CI), 2.29-5.48), 12.1% of LTCD (aRR, 2.59; 95% CI, 1.77-3.77), and 10.3% of LVCD (aRR, 2.27; 95% CI, 0.68-7.55) experienced complications. There was no significant difference in complication rates between CCD and LTCD (aRR, 1.37; 95% CI, 0.95-1.97) or between CCD and LVCD (aRR, 1.56; 95% CI, 0.48-5.07). Conclusion The risk of maternal complications after early preterm delivery is substantial, particularly in women who undergo cesarean delivery. Obstetricians need to be prepared to manage potential hemorrhage, infection, and intensive care unit admission for early preterm births requiring cesarean delivery.

    AB - Objective We sought to describe the prevalence of serious maternal complications following early preterm birth by gestational age (GA), delivery route, and type of cesarean incision. Study Design Trained personnel abstracted data from maternal and neonatal charts for all deliveries on randomly selected days representing one third of deliveries across 25 US hospitals over 3 years (n = 115,502). All women delivering nonanomalous singletons between 23-33 weeks' gestation were included. Women were excluded for antepartum stillbirth and highly morbid conditions for which route of delivery would not likely impact morbidity including nonreassuring fetal status, cord prolapse, placenta previa, placenta accreta, placental abruption, and severe and unstable maternal conditions (cardiopulmonary collapse, acute respiratory distress syndrome, seizures). Serious maternal complications were defined as: hemorrhage (blood loss ≥1500 mL, blood transfusion, or hysterectomy for hemorrhage), infection (endometritis, wound dehiscence, or wound infection requiring antibiotics, reopening, or unexpected procedure), intensive care unit admission, or death. Delivery route was categorized as classic cesarean delivery (CCD), low transverse cesarean delivery (LTCD), low vertical cesarean delivery (LVCD), and vaginal delivery. Association of delivery route with complications was estimated using multivariable regression models yielding adjusted relative risks (aRR) controlling for maternal age, race, body mass index, hypertension, diabetes, preterm premature rupture of membranes, preterm labor, GA, and hospital of delivery. Results Of 2659 women who met criteria for inclusion in this analysis, 8.6% of women experienced serious maternal complications. Complications were associated with GA and were highest between 23-27 weeks of gestation. The frequency of complications was associated with delivery route; compared with 3.5% of vaginal delivery, 23.0% of CCD (aRR, 3.54; 95% confidence interval (CI), 2.29-5.48), 12.1% of LTCD (aRR, 2.59; 95% CI, 1.77-3.77), and 10.3% of LVCD (aRR, 2.27; 95% CI, 0.68-7.55) experienced complications. There was no significant difference in complication rates between CCD and LTCD (aRR, 1.37; 95% CI, 0.95-1.97) or between CCD and LVCD (aRR, 1.56; 95% CI, 0.48-5.07). Conclusion The risk of maternal complications after early preterm delivery is substantial, particularly in women who undergo cesarean delivery. Obstetricians need to be prepared to manage potential hemorrhage, infection, and intensive care unit admission for early preterm births requiring cesarean delivery.

    KW - classic cesarean delivery

    KW - early preterm delivery

    KW - hemorrhage

    KW - infection

    KW - intensive care unit admission

    KW - maternal morbidity

    UR - http://www.scopus.com/inward/record.url?scp=84942297721&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=84942297721&partnerID=8YFLogxK

    U2 - 10.1016/j.ajog.2015.06.064

    DO - 10.1016/j.ajog.2015.06.064

    M3 - Article

    C2 - 26164696

    AN - SCOPUS:84942297721

    VL - 213

    SP - 538.e1-538.e9

    JO - American Journal of Obstetrics and Gynecology

    JF - American Journal of Obstetrics and Gynecology

    SN - 0002-9378

    IS - 4

    ER -